The Empirical Foundations of Telemedicine Interventions in Primary Care

In that Swiss RCT, sequential reminders reduced the rate of missed appointments by 11.4%.

“Overall, the sequential reminders reduced the rate of missed appointments by 11.4%.”

• cites [96] 96. Perron N, Dao M, Kossovsky M, et al. Reduction of missed appointments at an urban primary care clinic: A randomised controlled study. BMC Med Pract 2010;11:79. sourceDisputed

  The Abstract Results report that 11.4% was the missed-appointment rate in the control group, not the reduction. The intervention group's rate was 7.8%, a reduction of 3.6 percentage points. (LLM, conf=0.92)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

In a Malaysian RCT (n=931), nonattendance rates were 13.7% for the text messaging group, 15.6% for the telephone group, and 23.0% for the control group.

“The nonattendance rates for the three groups were 13.7% for the text messaging group, 15.6% for the telephone group, and 23.0% for the control group.”

• cites [95] 95. Liew SM, Tong SF, Lee VK, et al. Text messaging reminders to reduce non- attendance in chronic disease follow-up: A clinical trial. Br J Gen Pract 2009;59:916-920. sourceDisputed

  Table 2 (p. 919) assigns 13.7% non-attendance to telephone reminders and 15.6% to text messaging—the reverse of the claim. The control rate of 23.0% and total sample of 931 are correct. (LLM, conf=0.90)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

High utilizers of the portal messaging system were similar to low utilizers in visit frequency.

“High utilizers of the messaging system were also similar to low utilizers in terms of visit frequency.”

• cites [106] 106. North F, Crane S, Chaudhry R, et al. Impact of patient portal secure messages and electronic visits on adult primary care office visits. Telemed J E Health 2014;20:192-198. sourceDisputed

  The Discussion (page not available in our copy) says patients sending the most messages had higher numbers of face-to-face visits, not visit frequencies similar to low utilizers. Their own visit frequency did not change before versus after messaging; that is a different comparison. (LLM, conf=0.88)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

The key finding in this survey is that patients' positive expectations regarding the benefits of shared records were not matched by those of their physicians.

“The key finding in this survey is that patients' positive expectations regarding the benefits of shared records were not matched by those of their physicians.”

• cites [44] 44. Ross S, Todd J, Moore L, et al. Expectations of patients regarding patient accessible medical records. J Med Intern Res 2005;7:e13. sourceSupported

In that survey, patients in community health centers were somewhat more likely to anticipate problems with shared records.

“However, patients in community health centers were more sanguine about ''. the benefits of shared medical records'' (measured in terms of number of benefits: 7.9 vs. 7.1) and ''.somewhat more likely to anticipate problems with shared records.''”

• cites [44] 44. Ross S, Todd J, Moore L, et al. Expectations of patients regarding patient accessible medical records. J Med Intern Res 2005;7:e13. sourceSupported

In a 2006 U.S. survey of an urban family medicine practice, nearly 60% of patients with an Internet connection were willing to pay at least $10 a year for Web portal services.

“Of this latter group, nearly 60% were willing to pay at least $10 a year for Web portal services, and over 30% would pay $50 or more.”

• cites [45] 45. Adler K. Web portals in primary care: An evaluation of patient readiness and willingness to pay for online services. J Med Internet Res 2006;8:e26. sourceSupported

In a 2007 European study of Internet-based influenza-like illness monitoring (Gripenet), the electronic surveillance program offered significant advantages over traditional collaboration in terms of speed, flexibility, and uniform reporting of data.

“The electronic surveillance program offered significant advantages over traditional collaboration in terms of speed, flexibility, and the uniform (or standardized) reporting of data.”

• cites [49] 49. Van Noort S, Muehlen M, de Andrade R, et al. Gripenet: An Internet-based system to monitor influenza-like illness uniformly across Europe. Euro Surveill 2007;12:ES-E6. sourceSupported

More patients now have access to primary care services.

“More patients now have access to primary care services, but the primary care workforce is inadequate to meet the increased demand, and providers are responsible for increasing panel sizes (patient volume), raising concerns regarding the quality of care.36”

• cites [36] 36. Østbye T, Yarnall KS, Krause KM, et al. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005;3:209- 214. sourceCould not verify

  The Methods describe a theoretical panel of 2,500 patients, and the Discussion says physicians lack enough time to deliver recommended chronic disease care. Neither section reports that more patients now have access to primary care services; searches for increased access and demand found no such finding in our copy. (LLM, conf=0.73)

  Experimental — accuracy not yet measured

In a 2005 U.S. survey of patients and physicians, patients in both settings were equally likely to endorse shared medical records (94% vs 96%).

“Patients in both settings were ''equally likely to endorse shared medical records (94% vs. 96%).''”

• cites [44] 44. Ross S, Todd J, Moore L, et al. Expectations of patients regarding patient accessible medical records. J Med Intern Res 2005;7:e13. sourceSupported

In that survey, only 4.7% indicated their physicians asked them about Internet health information.

“About one-half (51%) of the respondents reported having searched the Internet for health information, but only 4.7% indicated that their physicians asked them about it, and 62.1% agreed that their ''doctors should recommend specific websites where patients can learn about healthcare.''”

• cites [43] 43. Diaz J, Sciamana C, Evangelou E, Stamp M, Ferguson T. Brief report: What types of Internet guidance do patients want from their physicians? J Gen Intern Med 2005;20:683-685. sourceSupported

In that survey, patients in community health centers reported more benefits of shared medical records than patients in academic medical center clinics (7.9 vs 7.1).

“However, patients in community health centers were more sanguine about ''. the benefits of shared medical records'' (measured in terms of number of benefits: 7.9 vs. 7.1) and ''.somewhat more likely to anticipate problems with shared records.''”

• cites [44] 44. Ross S, Todd J, Moore L, et al. Expectations of patients regarding patient accessible medical records. J Med Intern Res 2005;7:e13. sourceSupported

The primary care workforce is inadequate to meet the increased demand.

“More patients now have access to primary care services, but the primary care workforce is inadequate to meet the increased demand, and providers are responsible for increasing panel sizes (patient volume), raising concerns regarding the quality of care.36”

• cites [36] 36. Østbye T, Yarnall KS, Krause KM, et al. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005;3:209- 214. sourcePartly supported

  The Discussion (page not provided) concludes that primary care physicians lack enough time to deliver recommended chronic disease care, supporting a concern about care capacity and quality. It does not establish that more patients now have access, that demand has increased, or that providers are managing increasing panel sizes; its 2,500-patient panel is a model, not evidence of a trend. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

In a 2005 U.S. survey of primary care patients in Rhode Island, about 51% reported having searched the Internet for health information.

“About one-half (51%) of the respondents reported having searched the Internet for health information, but only 4.7% indicated that their physicians asked them about it, and 62.1% agreed that their ''doctors should recommend specific websites where patients can learn about healthcare.''”

• cites [43] 43. Diaz J, Sciamana C, Evangelou E, Stamp M, Ferguson T. Brief report: What types of Internet guidance do patients want from their physicians? J Gen Intern Med 2005;20:683-685. sourceSupported

In that Dutch study, only a small percentage of frail elderly people intensively used ZWIP, the online e-health tool.

“However, ''only a small percentage of frail elderly people in the study intensively used ZWIP [the online e-health tool].''”

• cites [74] 74. Makai P, Perry M, Robben S, et al. Evaluation of an eHealth intervention in chronic care for frail older people: Why adherence is the first target. J Med Internet Res 2014;16:e156. sourceSupported

In that Kaiser analysis, because of the large numbers, all differences were statistically significant.

“Because of the large numbers, all differences were statistically significant.”

• cites [81] 81. Garrido T, Jamieson L, Zhou Y, Wiesenthal A, Liang L. Effect of electronic health records in ambulatory care: Retrospective, serial, cross sectional study. BMJ 2005;330:581-585. sourcePartly supported

  The Statistical analysis section (p. 2) says the large sample size justified using a z test; it does not say that size made every difference significant. The Use of ambulatory care results (p. 3) report significant decreases in office visits, but the paper does not establish statistical significance for all differences it examined. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

In that survey, patient preferences for their health providers' social media were consistent with their own personal use of the same media.

“As expected, patient preferences for their health providers' social media were consistent with their own personal use of the same media.”

• cites [73] 73. Hanson CL, West J, Thackeray R, Bames M, Downey J. Understanding and predicting social medical use among community health center patients: A cross-sectional survey. J Med Internet Res 2014;16:e270. sourceSupported

The low response rate of 54% in that survey means that these results may not be reliable.

“However, the low response of 54% means that these results may not be reliable.”

• cites [75] 75. Polinski JM, Barker T, Gagliano N, et al. Patients' satisfaction with and preference for telehealth visits. J Gen Intern Med 2016;31:269-75. sourceSupported

In a Dutch quasi-experimental pre-post study of 682 frail elderly people, no significant differences were observed between those receiving instructions online versus those receiving instructions in-person.

“No significant differences were observed between those receiving instructions online versus those receiving instructions in-person.”

• cites [74] 74. Makai P, Perry M, Robben S, et al. Evaluation of an eHealth intervention in chronic care for frail older people: Why adherence is the first target. J Med Internet Res 2014;16:e156. sourcePartly supported

  The Results report 290 intervention participants and 392 controls, with no significant differences in primary patient outcomes after adjustment. But the Methods describe a comparison of practices using the ZWIP online care platform with control practices, not a comparison of online versus in-person instructions; face-to-face questionnaires were used to measure outcomes in both groups. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

In a Swiss RCT (n=6,450), the rate of missed appointments was similar in both groups: 11.7% for text messaging and 10.2% for telephone.

“The rate of missed appointments was similar in both groups (11.7% for text messaging and 10.2% for telephone).”

• cites [103] 103. Perron N, Dao M, Righini N, et al. Text-messaging versus telephone reminders to reduce missed appointments in an academic primary care clinic: A randomized controlled trial. BMC Health Serv Res 2013;13:125-131. sourceSupported

In that U.S. record review, death, hospitalization, and ED visits following a secure message or e-visit were infrequent.

“Death, hospitalization, and ED visits following a secure message or e-visit were infrequent.”

• cites [102] 102. North F, Crane S, Stroebel R, et al. Patient-generated secure messages and e- visits on a patient portal: Are patients at risk? J Am Med Inform Assoc 2013;20:1143-1149. sourceSupported

In a Swiss RCT (n=2,123), 12% of patients had no phone.

“Twelve percent of the patients had no phone.”

• cites [96] 96. Perron N, Dao M, Kossovsky M, et al. Reduction of missed appointments at an urban primary care clinic: A randomised controlled study. BMC Med Pract 2010;11:79. sourcePartly supported

  The Results report that 12% (127) of the 1,052 patients in the intervention group had no phone. The study included 2,123 patients overall, but the paper does not establish that 12% of the full sample had no phone. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

In that Chinese RCT, the cost of SMS was significantly lower than that for the telephone group.

“However, the cost of SMS was significantly lower than that for the telephone group.”

• cites [88] 88. Chen ZW, Fang LA, Chen LY, Dai HL. Comparison of an SMS text messaging and phone reminders to improve attendance at a health promotion center: A randomized controlled trial. J Zhejiang Univ Sci B 2008;9:34-38. sourceSupported

In that U.S. record review, large proportions of the messages on the portal were for information regarding medications and test results.

“Large proportions of the messages on the portal were for information regarding medications and test results.”

• cites [102] 102. North F, Crane S, Stroebel R, et al. Patient-generated secure messages and e- visits on a patient portal: Are patients at risk? J Am Med Inform Assoc 2013;20:1143-1149. sourceSupported

In that U.S. record review, about three-fourths of these messages and e-visits occurred during regular office hours.

“About three-fourths of these messages and e-visits occurred during regular office hours.”

• cites [102] 102. North F, Crane S, Stroebel R, et al. Patient-generated secure messages and e- visits on a patient portal: Are patients at risk? J Am Med Inform Assoc 2013;20:1143-1149. sourceSupported

In a Chinese RCT (n=1,859), attendance rates of SMS, telephone, and control groups were 87.5%, 88.3%, and 80.5%, respectively.

“Attendance rates of SMS, telephone, and controls were 87.5%, 88.3%, and 80.5%, respectively.”

• cites [88] 88. Chen ZW, Fang LA, Chen LY, Dai HL. Comparison of an SMS text messaging and phone reminders to improve attendance at a health promotion center: A randomized controlled trial. J Zhejiang Univ Sci B 2008;9:34-38. sourceSupported

In that U.S. record review, the median time to an appointment was 168 days before and 78 days after the intervention.

“The median time to an appointment was 168 days before and 78 days after the intervention.”

• cites [93] 93. Weiner M, Hoyek G, Wang L, et al. A web-based generalist-specialist system to improve scheduling of outpatient specialty consultation in an academic center. J Gen Intern Med 2009;24:710-715. sourceSupported

In that U.S. record review, patients used the portal messaging capability 3.5% of the time for potentially high-risk symptoms.

“Overall, patients used the portal messaging capability ''3.5% of the time for potentially high risk symptoms,'' such as chest pain, breathing difficulty, abdominal pain, palpations, light-headedness, and vomiting.”

• cites [102] 102. North F, Crane S, Stroebel R, et al. Patient-generated secure messages and e- visits on a patient portal: Are patients at risk? J Am Med Inform Assoc 2013;20:1143-1149. sourceSupported

In that U.S. record review, a subject line search to identify high-risk messages had a sensitivity of only 15% and a positive predictive value of 29%.

“However, ''.a subject line search to identify these high-risk messages had a sensitivity of only 15% and a positive predictive value of 29%.''”

• cites [102] 102. North F, Crane S, Stroebel R, et al. Patient-generated secure messages and e- visits on a patient portal: Are patients at risk? J Am Med Inform Assoc 2013;20:1143-1149. sourceSupported

In that Swiss RCT, the net financial benefit of the intervention was estimated to be e1,850 over 3 months once costs linked to the intervention were deducted.

“''The net financial benefit of the intervention was estimated to be e1,850 over 3 months.oncecosts linked to the intervention were deducted.''”

• cites [96] 96. Perron N, Dao M, Kossovsky M, et al. Reduction of missed appointments at an urban primary care clinic: A randomised controlled study. BMC Med Pract 2010;11:79. sourceSupported

In a U.S. record review of 40,487 referrals, before a Web-based referral system, 54% of contacts resulted in a scheduled specialty visit, compared with 83% after the intervention.

“Before the intervention, 54% of contacts resulted in a scheduled specialty visit, compared with 83% after the intervention.”

• cites [93] 93. Weiner M, Hoyek G, Wang L, et al. A web-based generalist-specialist system to improve scheduling of outpatient specialty consultation in an academic center. J Gen Intern Med 2009;24:710-715. sourceSupported

The fact that one in five telephone consultations resulted in a prescription demonstrates the need for care during the times when the primary care clinic is closed.

“The fact that one in five telephone consultations resulted in a prescription demonstrates the need for care during the times when the primary care clinic is closed.”

• cites [109] 109. Moth G, Huibers L, Christensen MB, Vedsted P. Drug prescription by telephone consultation in Danish out-of-hours primary care: A population-based study of frequency and associations with clinical severity and diagnosis. Fam Pract 2014;15:142. sourceSupported

• AssumptionRests on an assumption: In Denmark, GPs answer all telephone calls during off-hours and typically resolve 60% of the problems by providing medical advice and/or prescriptions.

In that Danish survey, for high-severity contacts, there was a lower likelihood for prescription (prevalence ratio = 0.28).

“However, for high-severity contacts, there was a lower likelihood for prescription (prevalence ratio = 0.28)”

• cites [109] 109. Moth G, Huibers L, Christensen MB, Vedsted P. Drug prescription by telephone consultation in Danish out-of-hours primary care: A population-based study of frequency and associations with clinical severity and diagnosis. Fam Pract 2014;15:142. sourceSupported

In that U.S. survey, those who were older, unemployed, and in poorer health were more likely to share their visit notes than their counterparts.

“Those who were older, unemployed, and in poorer health were more likely to do so than their counterparts.”

• cites [105] 105. Jackson S, Meijilla R, Darer J, et al. Patients who share transparent visit notes with others: Characteristics, risks and benefits. J Med Internet Res 2014;16:e247. sourceSupported

In that U.S. survey, 55% of respondents expressed an interest in allowing a family member or a friend access to their visit notes.

“Overall, 55% of the respondents expressed an interest in allowing a family member or a friend access to their visit notes.”

• cites [105] 105. Jackson S, Meijilla R, Darer J, et al. Patients who share transparent visit notes with others: Characteristics, risks and benefits. J Med Internet Res 2014;16:e247. sourceSupported

In the Finnish RCT, the analysis adjusted for confounding factors such as age, gender, comorbidities, and medications.

“especially when the data were adjusted for confounding factors such as age, gender, comorbidities, and medications.”

• cites [108] 108. Kortteisto T, Ritanen J, Kmulainen J, et al. Patient-specific computer-based decision support in primary healthcare-A randomized trial. Implement Sci 2014;9:15. sourceSupported

In that U.S. survey, those willing to share their visit notes were not particularly concerned about privacy or divulging sensitive information about themselves, such as substance abuse, mental health, or sexual history.

“Those willing to share their visit notes were not particularly concerned about privacy or divulging sensitive information about themselves, such as substance abuse, mental health, or sexual history.”

• cites [105] 105. Jackson S, Meijilla R, Darer J, et al. Patients who share transparent visit notes with others: Characteristics, risks and benefits. J Med Internet Res 2014;16:e247. sourcePartly supported

  The Results and Discussion (page not available in our copy) report that patients who shared notes were no more or less concerned about privacy than non-sharers. That does not establish that they were not particularly concerned: the Discussion says a sizable minority expressed privacy concerns. It identifies substance use, mental health, and sexual history as potentially sensitive, but does not report a separate finding about willingness to divulge those details. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

In that Finnish RCT, after 6 months, the incidence of reminders was significantly lower in the intervention group compared with the control group, especially when adjusted for confounding factors such as age, gender, comorbidities, and medications.

“However, after 6 months, the incidence of reminders was significantly lower in the intervention group compared with the control group, especially when the data were adjusted for confounding factors such as age, gender, comorbidities, and medications.”

• cites [108] 108. Kortteisto T, Ritanen J, Kmulainen J, et al. Patient-specific computer-based decision support in primary healthcare-A randomized trial. Implement Sci 2014;9:15. sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

No significant change in face-to-face visit frequency was observed following implementation of portal messaging.

“No significant change in face-to-face visit frequency was observed following implementation of portal messaging.”

• cites [106] 106. North F, Crane S, Chaudhry R, et al. Impact of patient portal secure messages and electronic visits on adult primary care office visits. Telemed J E Health 2014;20:192-198. sourceSupported

In that Danish survey, consultations for children had a lower likelihood of receiving a prescription compared with consultations for adults.

“consultations for children had a lower likelihood of receiving a prescription compared with consultations for adults.”

• cites [109] 109. Moth G, Huibers L, Christensen MB, Vedsted P. Drug prescription by telephone consultation in Danish out-of-hours primary care: A population-based study of frequency and associations with clinical severity and diagnosis. Fam Pract 2014;15:142. sourceSupported

In adult patients in a large primary care practice, after adjusting for the initial surge in visits, the average annual number of visits per patient was 2.35 both before and after the first portal message.

“After adjusting for the initial surge in visits, the average annual number of visits per patient was 2.35, both before and after the first message.”

• cites [106] 106. North F, Crane S, Chaudhry R, et al. Impact of patient portal secure messages and electronic visits on adult primary care office visits. Telemed J E Health 2014;20:192-198. sourceSupported

In that Spanish survey, the data on quality and hospital referrals were based on respondent perceptions.

“The data on quality and hospital referrals were based on respondent perceptions.”

• cites [110] 110. Diaz-Chao A, Torrent-Sellens J, Lacasta-Tintorer D, Saighi-Rubio F. Improving integrated care: Modelling the performance of an online community practice. Int J Integr Care 2014;14:e007. eCollection 2014. sourceSupported

In that RCT, patients with the lowest follow-up rate (English speakers with specialty care appointments) benefited the most from the intervention.

“patients with the lowest follow-up rate (English speakers with specialty care appointments) benefited the most from the intervention.”

• cites [107] 107. Arora S, Burner E, Terp S, et al. Improving attendance at post-emergency department follow-up via automated text message appoint reminders: A randomized controlled trial. Acad Emerg Med 2014;22:31-37. sourceSupported

In a Danish survey of GPs, respondents reported that 19.9% of telephone consultations resulted in a prescription.

“The respondents reported that 19.9% of the telephone consultations resulted in a prescription.”

• cites [109] 109. Moth G, Huibers L, Christensen MB, Vedsted P. Drug prescription by telephone consultation in Danish out-of-hours primary care: A population-based study of frequency and associations with clinical severity and diagnosis. Fam Pract 2014;15:142. sourcePartly supported

  The Abstract Results report that medication was prescribed in 19.9% of the included telephone consultations. But the Abstract Methods say prescription data came from the patient administration system, not from the GP respondents’ reports. The percentage is supported; its characterization as respondent-reported is not. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Secure messaging and e-visits through a patient portal may not result in a change of adult primary care face-to-face visits.

“Secure messaging and e-visits through a patient portal may not result in a change of adult primary care face-to-face visits.”

• cites [106] 106. North F, Crane S, Chaudhry R, et al. Impact of patient portal secure messages and electronic visits on adult primary care office visits. Telemed J E Health 2014;20:192-198. sourceSupported

In a 2011 U.S. RCT, after 24 months, weight losses in the two intervention groups (remote support and remote support plus in-person support) were 4.6 kg and 5.1 kg, respectively, whereas weight loss in the control group was 0.8 kg.

“After 24 months, weight losses in the two intervention groups-support by the three media and support by the three media plus in-person support-were 4.6 kg and 5.1 kg, respectively, whereas weight loss in the control group was 0.8 kg.”

• cites [120] 120. Appel L, Clark J, Yeh HC, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med 2011;365:1959-1968. sourceSupported

In a Zanzibar RCT, more women in the intervention group received the recommended four or more antenatal visits compared with those in the control group (43.8% versus 31.1%, respectively).

“More women in the intervention group received the recommended four or more antenatal visits compared with those in the control group (43.8% versus 31.1%,respectively).”

• cites [125] 125. Lund S, Rasch V, Hemed M, et al. Mobile phone intervention reduces perinatal mortality in Zanzibar: Secondary outcomes of a cluster randomized controlled trial. JMIR Mhealth Uhealth 2014;21:e15. sourceSupported

In that Zanzibar RCT, children born by women in the intervention group had a 50% reduction in perinatal mortality compared with children born by women in the control group.

“''Children born by women in the intervention group had a 50% reduction in perinatal mortality compared with children born by women in the control group.''”

• cites [125] 125. Lund S, Rasch V, Hemed M, et al. Mobile phone intervention reduces perinatal mortality in Zanzibar: Secondary outcomes of a cluster randomized controlled trial. JMIR Mhealth Uhealth 2014;21:e15. sourceSupported

The Zanzibar RCT explained the perinatal mortality difference on the basis of improving women's choices of care and access to care during pregnancy and in the time surrounding delivery.

“This difference was explained on the basis of ''improving women's choices of care and access to care during pregnancy and in the time surrounding delivery.''”

• cites [125] 125. Lund S, Rasch V, Hemed M, et al. Mobile phone intervention reduces perinatal mortality in Zanzibar: Secondary outcomes of a cluster randomized controlled trial. JMIR Mhealth Uhealth 2014;21:e15. sourcePartly supported

  The Discussion (Comparison With Other Studies; page not provided) says the intervention sought to improve decisions to seek care and access to an obstetric facility, and the Results report more antenatal visits and skilled delivery attendance in intervention clusters. But the Discussion explicitly says the authors could not explain the exact factors behind the reduction in perinatal mortality. The claim presents those improvements as an established explanation rather than a possible one. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

In that 2010 U.S. RCT, results indicated significant increases in daily steps in both intervention and control groups.

“The results indicated significant increases in daily steps in both intervention and control groups.”

• cites [119] 119. Richardson C, Buis L, Janney A, et al. An online community improves adherence in an Internet-mediated walking program. Part 1: Results of a randomized controlled trial. J Med Internet Res 2010;12:e71. sourceSupported

In that 2010 U.S. RCT, the percentage of participants who remained throughout the study period was 13% higher in the online community compared with the control group.

“However, the percentage of participants who remained (did not drop out) throughout the study period was 13% higher in the ''online community'' compared with those in the control group.”

• cites [119] 119. Richardson C, Buis L, Janney A, et al. An online community improves adherence in an Internet-mediated walking program. Part 1: Results of a randomized controlled trial. J Med Internet Res 2010;12:e71. sourceSupported

In that 2010 U.S. RCT, participants who started out with lower social support posted more messages and viewed more posts compared with those who started out with higher social support.

“Participants who started out with lower social support posted more messages and viewed more posts compared with those who started out with higher social support.”

• cites [119] 119. Richardson C, Buis L, Janney A, et al. An online community improves adherence in an Internet-mediated walking program. Part 1: Results of a randomized controlled trial. J Med Internet Res 2010;12:e71. sourceSupported

In a 2008 Group Health Cooperative study, findings indicate a significant decline in cost between baseline and full implementation resulting from gains in productivity and clinical efficiency.

“The findings indicate a significant decline in cost between baseline and full implementation resulting from gains in productivity and clinical efficiency.”

• cites [129] 129. Conrad D, Fishman P, Grembowski D, et al. Access intervention in an integrated, prepaid group practice: Effects on primary care physician productivity. Health Serv Res 2008;53:1888-1905. sourcePartly supported

  The Abstract reports a significant decline in per-member-per-quarter cost between baseline and full implementation, alongside improvements in productivity and clinical efficiency. The Conclusions caution that, without a comparable control group, the study cannot infer direct causal effects; the claim's assertion that the cost decline resulted from those gains overstates the evidence. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

In that 2011 U.S. RCT, the percentages of participants who lost 5% or more of their weight in the two interventions were 38.2% and 41.4%, versus 18.8% in the control group.

“The percentages of participants who lost 5% or more of their weight in the two respective interventions were 38.2% and 41.4%, versus only 18.8% in the control group.”

• cites [120] 120. Appel L, Clark J, Yeh HC, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med 2011;365:1959-1968. sourceSupported

In the 2014 UK telecare trial, given the difficulty of estimating actual costs of rapidly changing technology and low response rates, the findings must be treated with caution.

“However, given the difficulty of estimating the actual costs of a rapidly changing technology, as well as the low response rates in the survey, these findings must be treated with caution.”

• cites [135] 135. Henderson C, Knapp M, Fernandez JL, et al. Cost-effectiveness of telecare for people with social care needs: The Whole Systems Demonstrator cluster randomized trial. Age Ageing 2014;43:794-800. sourcePartly supported

  The Discussion (page unavailable) identifies limited questionnaire-study participation, substantial follow-up loss, and missing resource-use data as limitations that could affect the findings. The Results’ sensitivity analyses vary telecare equipment and support costs, but the paper does not say that rapidly changing technology made actual costs difficult to estimate. That stated reason for caution is not supported by our copy. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

In the 2014 Canadian cost-effectiveness analysis, mobile app follow-up care for low-risk postoperative ambulatory surgical patients can be cost effective from a societal and healthcare system perspective.

“The analysis reveals that mobile app follow-up care for low-risk postoperative ambulatory surgical patients can be cost effective from a societal and healthcare system perspective.”

• cites [136] 136. Armstrong K, Semple J, Coyte P. Replacing ambulatory surgical follow-up with mobile app home monitoring: Modeling cost-effective scenarios. J Med Internet Res 2014;16:e213. sourceSupported

In the 2014 UK telecare trial, 40% of the control group and 32% of the telecare group dropped out at the 12-month follow-up.

“a sizeable proportion of both groups dropped out of the study at the 12-month follow-up: 40% of the control group and 32% of the telecare group.”

• cites [135] 135. Henderson C, Knapp M, Fernandez JL, et al. Cost-effectiveness of telecare for people with social care needs: The Whole Systems Demonstrator cluster randomized trial. Age Ageing 2014;43:794-800. sourceSupported

In that Swedish study, use rates increased more rapidly among young and middle-aged women than other segments of the population.

“A trend analysis of utilization data revealed that use rates increased more rapidly among young and middle-aged women than other segments of the population.”

• cites [50] 50. Umefjord G, Sandstrom H, Malker H, Petersson G. Medical text-based consultations on the Internet: A 4-year study. Int J Med Inform 2008;77: 114-121. sourceNot checked — no full text of the source

In a 2007 Danish telephone survey, about 60% of respondents reported using the Internet for health-related information.

“About 60% of the respondents reported doing so.”

• cites [47] 47. Voss H, Ravn B. Danes and their use of the Internet for health-related purposes [in Danish]. Ugeskr Laeger 2007;169:2318-2321.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The included studies were conducted in 14 countries.

“The majority (23 out of 35) were based on surveys, with sample sizes ranging from 100 to 652,337, and conducted in 14 countries, nearly 50% from the United States (15 out of 35).”

The majority of studies support the feasibility/acceptance of telemedicine for use in primary care.

“The majority of studies support the feasibility/acceptance of telemedicine for use in primary care, although it varies significantly by demographic variables, such as gender, age, and socioeconomic status”

Telemedicine has often been found more acceptable by patients than healthcare providers.

“telemedicine has often been found more acceptable by patients than healthcare providers.”

In a Swedish study of 38,217 Internet inquiries over 4 years, based on 2002 data (n=16,306), the typical user was a woman between 21 and 60 years of age.

“Based on analysis of data from the last year (2002) of the project (n = 16,306), the typical user was a woman between 21 and 60 years of age.”

• cites [50] 50. Umefjord G, Sandstrom H, Malker H, Petersson G. Medical text-based consultations on the Internet: A 4-year study. Int J Med Inform 2008;77: 114-121. sourceNot checked — no full text of the source

In that Swedish study, almost one-half of the inquiries were submitted during evening and night hours when clinics are not open.

“Almost one-half of the inquiries were submitted during evening and night hours when clinics are not open.”

• cites [50] 50. Umefjord G, Sandstrom H, Malker H, Petersson G. Medical text-based consultations on the Internet: A 4-year study. Int J Med Inform 2008;77: 114-121. sourceNot checked — no full text of the source

Acceptance of telemedicine for use in primary care varies significantly by demographic variables such as gender, age, and socioeconomic status.

“The majority of studies support the feasibility/acceptance of telemedicine for use in primary care, although it varies significantly by demographic variables, such as gender, age, and socioeconomic status”

In a 2006 Norwegian telephone survey, more than half (58%) of respondents had used the Internet for health purposes in 2005, compared with 31% in 2001.

“More than one-half (58%) of the respondents had used the Internet for health purposes in 2005, compared with only 31% in 2001.”

• cites [46] 46. Andreassen HK, Wangberg SC, Wynn R, et al. Health-related use of the Internet in the Norwegian population [in Norwegian]. Tidsskr Nor Laegenforen 2006;126:2950-2952.Not checked — no full text of the source

From 2005 through 2015, 35 studies met the final eligibility criteria for this analysis.

“From 2005 through 2015, 35 studies met the final eligibility criteria for this analysis.”

In a Netherlands study of telephone consultations for palliative cancer care, 84% of patients were treated at home by their GPs.

“Eighty-four percent of the patients were treated at home by their GPs.”

• cites [48] 48. Teunissen S, Verhagen E, Brink M, et al. Telephone consultation in palliative care for cancer patients: 5 years of experience in The Netherlands. Support Care Cancer 2007;15:577-582. sourceNot checked — no full text of the source

The majority (23 of 35) of the included feasibility studies were based on surveys.

“The majority (23 out of 35) were based on surveys, with sample sizes ranging from 100 to 652,337, and conducted in 14 countries, nearly 50% from the United States (15 out of 35).”

In total, 35 studies met the inclusion criteria for studies concerned with intermediate outcomes of telemedicine intervention in primary care.

“In total, 35 studies met the inclusion criteria for studies concerned with the intermediate outcomes of the telemedicine intervention in primary care.”

In that RCT, control patients reported more medication changes than intervention patients (29% versus 15%).

“On the other hand, control patients reported more medication changes then intervention patients (29% versus 15%).”

• cites [55] 55. Leveille S, Huang A, Tsai S, et al. Health coaching via an Internet portal for primary care patient with chronic conditions: A randomized control trial. Med Care 2009;47:41-47. sourceNot checked — no full text of the source

In that British RCT, text messaging did not produce a demonstrable reduction in nonattendance among repeat nonattenders.

“Although somewhat promising, text messaging did not produce demonstrable reduction in nonattendance among repeat nonattenders.”

• cites [87] 87. Fairhurst K, Sheikh A. Texting appointment reminders to repeated non- attenders in primary care: Randomised controlled study. Qual Saf Health Care 2008;17:373-376. sourceNot checked — no full text of the source

A 2008 Canadian study found that physicians' use of electronic information about patients is inversely related to SES of patients.

“The data suggest that physicians' use of electronic information about patients is inversely related to SES of patients.”

• cites [52] 52. Kawasumi Y, Tamblyn R, Platt R, et al. Evaluation of the use of an integrated drug information system by primary care physicians for vulnerable population. Int J Med Inform 2008;77:98-106. sourceNot checked — no full text of the source

In a U.S. kiosk survey of 4,014 people, about 12% of individuals who completed the kiosk health risk assessment questionnaire on their own had a health problem that required further investigation.

“This means that about 12% of individuals who completed the kiosk health risk assessment questionnaire on their own had a health problem that required further investigation.”

• cites [53] 53. Lobach D, Siley G, Willis J, et al. Coupling direct collection of health risk information from patients through kiosks with decision support for proactive management. AMIA Annu Symp Proc 2008:429-433.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

In a U.S. controlled trial (n=212) of patients with sinusitis, after 6 months a greater proportion of patients in the nurse-based telephone protocol intervention group received first-line antibiotics compared with the usual care group (81% versus 53%).

“After 6 months, a greater proportion of patients in the intervention group received firstline antibiotics for the infection compared with those in the usual group (81% versus 53%, respectively).”

• cites [83] 83. Chaudhry R, Stroebel R, McLeod T, et al. Nurse-based telephone protocol versus usual care for management of URI and acute sinusitis: A controlled trial. Manag Care Interface 2006;19:26-31.Not checked — no full text of the source

In that Norwegian RCT, there were no differences in the number of telephone consultations between the intervention and control groups.

“However, there were no differences in the number of telephone consultations between the two groups.”

• cites [80] 80. Bergmo TS, Kummervold PE, Gammon D, Dahl LB. Electronic patient-provider communication: Will it offset office visits and telephone consultations in primary care? Int J Med Inform 2005;74:705-710. sourceNot checked — no full text of the source

In the Norwegian RCT (n=200), the reduction in office visits over time was greater for the intervention group using text messaging than for the control group.

“''The reduction in office visits over time was greater for the intervention group [using text messaging] than for the control group.''”

• cites [80] 80. Bergmo TS, Kummervold PE, Gammon D, Dahl LB. Electronic patient-provider communication: Will it offset office visits and telephone consultations in primary care? Int J Med Inform 2005;74:705-710. sourceNot checked — no full text of the source

In that study, physicians were more likely to access electronic information on current drug use of patients of low SES taking multiple medications with fragmented care.

“That is, physicians were ''more likely to access electronic information on current drug use of patients of low SES taking multiple medications with fragmented care.''”

• cites [52] 52. Kawasumi Y, Tamblyn R, Platt R, et al. Evaluation of the use of an integrated drug information system by primary care physicians for vulnerable population. Int J Med Inform 2008;77:98-106. sourceNot checked — no full text of the source

In the Scotland SMS study, service uptake was slow even by younger patients.

“However, ''service uptake was slow'' even by younger patients.”

• cites [54] 54. Neville RG, Reed C, Boswell B, et al. Early experience of the use of short message service (SMS) technology in routine clinical care. Inform Prim Care 2008;16:203-211. sourceNot checked — no full text of the source

In 2007, one study met the inclusion criteria: a retrospective record review of 241 patients with URI symptoms in a primary care practice.

“One study in 2007 met the inclusion criteria for this review.It was a retrospective record review of patients (n = 241) having URI symptoms and presenting in a primary care practice.”

In a Malaysian RCT (n=993), attendance rates for telephone, text messaging, and control groups were 59.6%, 59.0%, and 48.1%, respectively.

“Attendance rates for telephone, text messaging, and control groups were 59.6%, 59.0%, and 48.1%, respectively.”

• cites [85] 85. Leong KC, Chen WS, Leong KW, et al. The use of text messaging to improve attendance in primary care: A randomized controlled trial. Fam Pract 2006;23:699-705. sourceNot checked — no full text of the source

About one-third of the 35 intermediate-outcome studies were based on RCT designs (9 out of 35).

“About one-third were based on RCT designs (9 out of 35).”

In a Scotland SMS study, most patients reported being pleasantly surprised at the system's convenience and ease of use.

“Most patients reported being ''pleasantly surprised' at the system's convenience and ease of use.”

• cites [54] 54. Neville RG, Reed C, Boswell B, et al. Early experience of the use of short message service (SMS) technology in routine clinical care. Inform Prim Care 2008;16:203-211. sourceNot checked — no full text of the source

In a U.S. quasi-experiment with 3,772 Medicare patients, there was a 44% reduction in 30-day readmissions in the study cohort when using the control group with case management only to control for secular trends.

“The results indicate ''a 44% reduction in 30-day readmissions in the study cohort, when using the control group [with case management only] to control for secular trends.''”

• cites [100] 100. Graham J, Tomcavage J, Salek D, et al. Postdischarge monitoring using interactive voice response system reduces 30-day readmission rates in a case- managed Medicare population. Med Care 2012;50:50-57. sourceNot checked — no full text of the source

In a UK audit (n=416) of Choose and Book, 30.2% of patients booked traditionally did not attend, compared with 17.8% of those who used the electronic system.

“Among patients booked in the traditional mode, 30.2% did not attend, compared with 17.8% among those who used the electronic system.”

• cites [94] 94. Parmar V, Large A, Madden C, Das V. The online outpatient booking system 'Choose and Book' improves attendance rates at an audiology clinic: A comparative audit. Inform Prim Care 2009;17:183-186. sourceNot checked — no full text of the source

In that Canadian survey, when the information source used by physicians was not specified, 9% and 7% of patients reported decreased confidence.

“Interestingly, when the information source used by the physicians was not specified, ''9% and 7% of patients reported decreased confidence.''”

• cites [99] 99. Kahane S, Stutz E, Aliarzadeh B. Must we appear to be all-knowing? Patients' and family physicians' perspectives on information seeking during consultations. Can Fam Physician 2011;57:e228-e236.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

In that U.S. record review, after adjusting for comorbidity, age, sex, and marital status, the odds of an early return visit for any reason after an e-consult were elevated (odds ratio = 1.88).

“After adjusting for comorbidity, age, sex, and marital status, the odds of an early return visit for any reasons after an e-consult were elevated (odds ratio = 1.88).”

• cites [92] 92. Angstman KB, Rohrer JE, Adamson SC, Chaudhry R. Impact of e-consults on return visits of primary care patients. Health Care Manag (Frederick) 2009;28:253-257. sourceNot checked — no full text of the source

In that Canadian survey, when the source was specified, negative responses were higher (46% versus 9%).

“On the other hand, when the source was specified, the negative responses were higher (46% versus 9%).”

• cites [99] 99. Kahane S, Stutz E, Aliarzadeh B. Must we appear to be all-knowing? Patients' and family physicians' perspectives on information seeking during consultations. Can Fam Physician 2011;57:e228-e236.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

In a Canadian survey (n=153 patients, 54 family physicians, and 21 family practice residents), patients younger than 40 years of age were 8 times more likely to report decreased confidence than patients older than 65 years age.

“Overall, ''patients younger than 40 years of age were 8 times more likely to report decreased confidence than patients older than 65 years age.''”

• cites [99] 99. Kahane S, Stutz E, Aliarzadeh B. Must we appear to be all-knowing? Patients' and family physicians' perspectives on information seeking during consultations. Can Fam Physician 2011;57:e228-e236.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

In a Zanzibar cluster-RCT (n=2,550), skilled delivery attendance was observed in 60% of women in the intervention group versus 47% in the control group.

“Skilled delivery attendance was observed in 60% of women in the intervention group versus 47% in the control group.”

• cites [101] 101. Lund S, Hemed M, Nielsen BB, et al. Mobile phones as a health communication tool to improve skilled attendance at delivery in Zanzibar: A cluster- randomised controlled trial. BJOG 2012;119:1256-1264. sourceNot checked — no full text of the source

In that Swedish study, there were significant differences between incoming (from patients) and outgoing reports (by nurses).

“There were significant differences between incoming (from the patients) and outgoing reports (by the nurses).”

• cites [97] 97. Ernesa ¨ter A, Engstro ¨m M, Holmstro ¨m I, Winblad U. Incident reporting in nurse- led national telephone triage in Sweden: The reported errors reveal a pattern that needs to be broken. J Telemed Telecare 2010;16:243-247. sourceNot checked — no full text of the source

In a U.S. retrospective record review (case-control, n=728), the return rate for visits for the e-consult group was higher than for in-person consults: 38.2% versus 27.6%.

“The results showed a higher return rate for visits for the e-consult group compared with in-person consults: 38.2% versus 27.6%, respectively.”

• cites [92] 92. Angstman KB, Rohrer JE, Adamson SC, Chaudhry R. Impact of e-consults on return visits of primary care patients. Health Care Manag (Frederick) 2009;28:253-257. sourceNot checked — no full text of the source

In a U.S. analysis of 20,230 calls to a telephone triage center, 46 had a diagnosis of appendicitis.

“There were 20,230 calls to a telephone triage center.Among these, 46 had a diagnosis of appendicitis.”

• cites [98] 98. North F, Odunukan O, Varkey P. The value of telephone triage for patients with appendicitis. J Telemed Telecare 2011;17:417-420. sourceNot checked — no full text of the source

In that Teledoc study, Teledoc users were not more likely to be located within a healthcare professional shortage area.

“In terms of access, ''Teledoc users were not more likely to be located within a healthcare professional shortage area.''”

• cites [113] 113. Uscher-Pines L, Mulcahy A, Cowling D, et al. Access and quality of care in direct-to-consumer telemedicine. Telemed J E Health 2016;22:282-287. sourceNot checked — no full text of the source

In a prospective controlled study in Mali, children in the intervention group received more primary care services than those in the control group, with an odds ratio of 2.2.

“As expected, children in the intervention group received more primary care services than those in the control group, with an odds ratio of 2.2.”

• cites [104] 104. Simonyan D, Gagnon MP, Duschesne T, Roos-Weil A. Effects of a telehealth programme using mobile data transmission on primary healthcare utilization among children in Bamako, Mali. J Telemed Telecare 2013;19: 302-306. sourceNot checked — no full text of the source

In that Mali study, children who participated in the Pesinet program were more than twice as likely to get primary care services compared with nonparticipants.

“In other words, children who participated in the Pesinet program were more than twice as likely to get primary care services compared with nonparticipants.”

• cites [104] 104. Simonyan D, Gagnon MP, Duschesne T, Roos-Weil A. Effects of a telehealth programme using mobile data transmission on primary healthcare utilization among children in Bamako, Mali. J Telemed Telecare 2013;19: 302-306. sourceNot checked — no full text of the source

In a Scotland survey, the availability of a key information summary on electronic patient records for unscheduled care providers during off-hours enhances patient safety.

“The findings suggest that the availability of ''key information summary enhances patient safety, improves clinical management, reduces hospital admissions, empowers clinicians, aids communication across services and enables decisions to be responsive to patients' wishes.''”

• cites [117] 117. Craig J, Morris L, Cameron J, et al. An evaluation of the impact of the key information summary on GPs and out-of-hours clinicians in NHS Scotland. Scott Med J 2015;60:126-131. sourceNot checked — no full text of the source

In a 2015 U.S. record review of Teledoc users, Teledoc users were more likely to be younger and female.

“Teledoc users were more likely to be younger and female.”

• cites [113] 113. Uscher-Pines L, Mulcahy A, Cowling D, et al. Access and quality of care in direct-to-consumer telemedicine. Telemed J E Health 2016;22:282-287. sourceNot checked — no full text of the source

In that Teledoc study, for pharyngitis, Teledoc performed worse than physician offices (3% versus 50%).

“For pharyngitis, ''Teledoc performed worse than physician offices (3% versus 50% respectively);''”

• cites [113] 113. Uscher-Pines L, Mulcahy A, Cowling D, et al. Access and quality of care in direct-to-consumer telemedicine. Telemed J E Health 2016;22:282-287. sourceNot checked — no full text of the source

In that Teledoc study, for back pain (as indicated by not ordering imaging), Teledoc performed 88% versus 79% for physician offices.

“for back pain (as indicated by not ordering imaging), 88% versus 79%;”

• cites [113] 113. Uscher-Pines L, Mulcahy A, Cowling D, et al. Access and quality of care in direct-to-consumer telemedicine. Telemed J E Health 2016;22:282-287. sourceNot checked — no full text of the source

In that Teledoc study, for bronchitis (not ordering antibiotics), Teledoc performed 16.7% versus 27.9% for physician offices.

“and for bronchitis (not ordering antibiotics), 16.7% versus 27.9%.”

• cites [113] 113. Uscher-Pines L, Mulcahy A, Cowling D, et al. Access and quality of care in direct-to-consumer telemedicine. Telemed J E Health 2016;22:282-287. sourceNot checked — no full text of the source

In a Canadian eConsult study, overall 40% of e-visits resulted in an avoided referral.

“Overall, 40% of the e-visits resulted in an avoided referral.”

• cites [116] 116. Tran C, Liddy C, Pinto N, Keely E. Impact of question content on e-consultation outcomes. Telemed J E Health 2016;22:216-222. sourceNot checked — no full text of the source

In that Central Australian study, the highest conditions for evacuations were respiratory disease and injuring/poisoning (20.5% and 19.2%, respectively).

“The highest conditions for evacuations were respiratory disease and injuring/poisoning (20.5% and 19.2%, respectively).”

• cites [111] 111. Hussain J, Robinson A, Stebbing M, McGrail M. More is more in remote Central Australia: More provision of primary healthcare is associated with more acute medical evacuations and more remote telephone consultations. Rural Remote Health 2014;14:2796. sourceNot checked — no full text of the source

In a Canadian RCT, there were no statistically significant differences in re-hospitalization or death between patients discharged to virtual wards compared with usual practice at 30 days, 90 days, 6 months, or 1 year after discharge.

“There were no statistically significant differences in re-hospitalization or death between patients discharged to virtual wards compared with usual practice at 30 days, 90 days, 6 months, or 1 year after discharge.”

• cites [112] 112. Dhalla I, O'Brien T, Morra D, et al. Effect of postdischarge virtual ward on readmission or death for high risk patients. A randomized clinical trial. JAMA 2014;312:1305-1312. sourceNot checked — no full text of the source

In Belize, hypertension-related deaths dropped from 1st cause of death in 2003 to 9th by 2010.

“''Hypertension related deaths dropped from 1 st cause of death in 2003 to 9 th by 2010.”

• cites [123] 123. Graven M, Allen P, Smith I, MacDonald N. Decline in mortality in the Belize integrated patient-centered country wide health information system (BHIS) with embedded program management. Int J Med Inform 2013;82:954-963. sourceNot checked — no full text of the source

In that Scotland survey, the availability of a key information summary aids communication across services.

“The findings suggest that the availability of ''key information summary enhances patient safety, improves clinical management, reduces hospital admissions, empowers clinicians, aids communication across services and enables decisions to be responsive to patients' wishes.''”

• cites [117] 117. Craig J, Morris L, Cameron J, et al. An evaluation of the impact of the key information summary on GPs and out-of-hours clinicians in NHS Scotland. Scott Med J 2015;60:126-131. sourceNot checked — no full text of the source

In that Scotland survey, the availability of a key information summary improves clinical management.

“The findings suggest that the availability of ''key information summary enhances patient safety, improves clinical management, reduces hospital admissions, empowers clinicians, aids communication across services and enables decisions to be responsive to patients' wishes.''”

• cites [117] 117. Craig J, Morris L, Cameron J, et al. An evaluation of the impact of the key information summary on GPs and out-of-hours clinicians in NHS Scotland. Scott Med J 2015;60:126-131. sourceNot checked — no full text of the source

In a Brazil survey, family physicians and dermatologists accounted for the majority of teleconsultations (33% and 19%, respectively).

“Family physicians and dermatologists accounted for the majority of teleconsultations (33% and 19%, respectively).”

• cites [118] 118. Marcolino MS, Pereira Afonso dos Santos J, Santos Neves D, Alkmim MB. Teleconsultations to provide support for primary care practitioners and improve quality of care-the experience of a large scale telehealth service in Brazil. Stud Health Technol Inform 2015;216:987. sourceNot checked — no full text of the source

In that Scotland survey, the availability of a key information summary reduces hospital admissions.

“The findings suggest that the availability of ''key information summary enhances patient safety, improves clinical management, reduces hospital admissions, empowers clinicians, aids communication across services and enables decisions to be responsive to patients' wishes.''”

• cites [117] 117. Craig J, Morris L, Cameron J, et al. An evaluation of the impact of the key information summary on GPs and out-of-hours clinicians in NHS Scotland. Scott Med J 2015;60:126-131. sourceNot checked — no full text of the source

In that Scotland survey, the availability of a key information summary enables decisions to be responsive to patients' wishes.

“The findings suggest that the availability of ''key information summary enhances patient safety, improves clinical management, reduces hospital admissions, empowers clinicians, aids communication across services and enables decisions to be responsive to patients' wishes.''”

• cites [117] 117. Craig J, Morris L, Cameron J, et al. An evaluation of the impact of the key information summary on GPs and out-of-hours clinicians in NHS Scotland. Scott Med J 2015;60:126-131. sourceNot checked — no full text of the source

In Belize, over 90% of all clinical encounters were entered into the Belize Health Information System during the first year.

“The deployment pace was high: over 90% of all clinical encounters were entered into the Belize Health Information System during the first year.”

• cites [123] 123. Graven M, Allen P, Smith I, MacDonald N. Decline in mortality in the Belize integrated patient-centered country wide health information system (BHIS) with embedded program management. Int J Med Inform 2013;82:954-963. sourceNot checked — no full text of the source

In that Norway study, the rate of willingness to pay was lower in the group that already had such access compared with those who did not.

“This rate was lower in the group that already had such access compared with those who did not.”

• cites [128] 128. Bergmo T, Wangberg S. Patients' willingness to pay for electronic communication with their general practitioner. Eur J Health Econ 2007;8:105-110. sourceNot checked — no full text of the source

In that Brazil survey, respondents reported that teleconsultations avoided patient referrals in 78% of cases.

“The respondents reported that ''teleconsultations avoided patient referrals in 78%'' of the cases”

• cites [118] 118. Marcolino MS, Pereira Afonso dos Santos J, Santos Neves D, Alkmim MB. Teleconsultations to provide support for primary care practitioners and improve quality of care-the experience of a large scale telehealth service in Brazil. Stud Health Technol Inform 2015;216:987. sourceNot checked — no full text of the source

In that Scotland analysis, the average cost per consultation was lower in the telephone group compared with in-person (€7.19 vs. €11.11).

“the average cost per consultation was lower in the telephone group compared with in-person (e7.19 vs. e11.11).”

• cites [127] 127. Pinnock H, McKenzie L, Price D, Sheikh A. Cost-effectiveness of telephone or surgery asthma reviews: Economic analysis of a randomized controlled trial. Br J Gen Pract 2005;55:119-124. sourceNot checked — no full text of the source

In that 2005 U.S. trial, cost savings were estimated for patients for whom travel was avoided (typically a 5-h flight and more than 1-week stay at the medical center).

“Cost savings were estimated for patients for whom travel was avoided (typically a 5-h flight and more than 1-week stay at the medical center.”

• cites [126] 126. Callahan C, Malone F, Estroff D, Person D. Effectiveness of an Internet-based store-and-forward telemedicine system for pediatric subspecialty consultation. Arch Pediatr Adolesc Med 2005;159:389-393. sourceNot checked — no full text of the source

In that 2005 U.S. trial, the total cost for 1 air evacuation in the model was estimated to be $5,794.

“''The total cost for 1 air evacuation in this model was estimated to be $5,794.''”

• cites [126] 126. Callahan C, Malone F, Estroff D, Person D. Effectiveness of an Internet-based store-and-forward telemedicine system for pediatric subspecialty consultation. Arch Pediatr Adolesc Med 2005;159:389-393. sourceNot checked — no full text of the source

In a 2005 U.S. prospective trial of Internet-based store-and-forward pediatric consultation, the average reply time to the initiating physician was 32 h with a standard deviation of 14 h.

“''Generally, the response time to the initiating physician was excellent.withan average reply time of 32 h and a standard deviation of 14 h.''”

• cites [126] 126. Callahan C, Malone F, Estroff D, Person D. Effectiveness of an Internet-based store-and-forward telemedicine system for pediatric subspecialty consultation. Arch Pediatr Adolesc Med 2005;159:389-393. sourceNot checked — no full text of the source

In that Scotland analysis, total respiratory costs of providing 101 telephone reviews were similar to those for 68 in-person reviews.

“Total respiratory costs of providing 101 telephone reviews were similar to those for 68 in-person reviews”

• cites [127] 127. Pinnock H, McKenzie L, Price D, Sheikh A. Cost-effectiveness of telephone or surgery asthma reviews: Economic analysis of a randomized controlled trial. Br J Gen Pract 2005;55:119-124. sourceNot checked — no full text of the source

In a 2005 Scotland cost-effectiveness analysis based on an RCT, telephone consultations were significantly shorter compared with surgery (average of 11.19 min versus 21.87 min).

“Telephone consultations were significantly shorter compared with surgery (average of 11.19 min versus 21.87 min).”

• cites [127] 127. Pinnock H, McKenzie L, Price D, Sheikh A. Cost-effectiveness of telephone or surgery asthma reviews: Economic analysis of a randomized controlled trial. Br J Gen Pract 2005;55:119-124. sourceNot checked — no full text of the source

In a 2007 Norway willingness-to-pay study, overall 52% of respondents were willing to pay for electronic contact with the GP.

“Overall, 52% of the respondents were willing to pay for the electronic contact with the GP.”

• cites [128] 128. Bergmo T, Wangberg S. Patients' willingness to pay for electronic communication with their general practitioner. Eur J Health Econ 2007;8:105-110. sourceNot checked — no full text of the source

Use of the Internet resulted in a 29% improvement in electronic scheduling appointments in specialty care.

“Use of the Internet had generally positive effects in several areas, including electronic scheduling appointments (29% improvement in specialty care), improved referral and booking, and identifying medication adverse events and addressing them.”

Physicians' concern regarding patients' apprehension when seeing them look up information on the Internet during the clinical encounter was not substantiated by the patients themselves.

“Physicians' concern regarding patients' apprehension when seeing them look up information on the Internet during the clinical encounter was not substantiated by the patients themselves.”

The common finding from feasibility/acceptance studies affirmed the feasibility and acceptance of telemedicine interventions in primary care by both patients and providers who used them.

“The common finding from these studies affirmed the feasibility and acceptance of telemedicine interventions in primary care by both patients and providers who used them.”

Patients tended to adhere to health advice and coaching provided by nurses over the telephone as a substitute for in-person visits.

“Patients tended to adhere to health advice and coaching provided by nurses over the telephone as a substitute for in-person visits.”

Reliance on the electronic health record resulted in a 9% decrease of office visits in a large health system over a 2-year period.

“Reliance on the electronic health record resulted in 9% decrease of office visits in a large health system over a 2year period, as well as modest improvement in quality.”

Appointment reminders by telephone and SMS texting resulted in improved clinic attendance by about 10 percentage points.

“Appointment reminders by telephone and SMS texting resulted in improved clinic attendance (converse of noshow) by about 10 percentage points, but cost of texting is lower.”

In that 2010 U.S. record review, the adjusted odds for being a cost outlier was substantially lower for the online group than for the standard visit group (odds ratio = 0.52).

“The adjusted odds for being a cost outlier was substantially lower for the online group than for the standard visit group (odds ratio = 0.52).”

• cites [132] 132. Rohrer JE, Angstman KB, Adamson SC, et al. Impact of online primary care visits on standard costs: A pilot study. Popul Health Manag 2010;13: 59-63. sourceNot checked — no full text of the source

There was no change in visit frequency to PCPs.

“There was no change in visit frequency to PCPs.”

Telemonitoring/case management reduced 30-day readmission by 30%.

“Telemonitoring/case management reduced 30-day readmission by 30%.”

Patients were satisfied with the convenience of e-visits and e-prescribing.

“Patients were satisfied with the convenience of e-visits and e-prescribing, and they equated e-consulting with in-person except for conditions that require physical examination, where they preferred in-person visits.”

Thirty-six studies met the inclusion criteria for evidence on intermediate outcomes.

“Thirty-six studies met the inclusion criteria for the evidence on intermediate outcomes: 15 from the United States, 4 each from Canada and the United Kingdom, and the remainder from 11 other countries.”

Most of the articles studying telemedicine that we reviewed did not significantly attend to issues of ethnicity, gender, or class.

“Most of the articles studying telemedicine that we reviewed did not significantly attend to issues of ethnicity, gender, or class.”

A stepped algorithm-driven clinician advice rendered over the telephone optimized analgesic medication among patients with risky drug use.

“A stepped algorithm-drive clinician advice rendered over the telephone optimized analgesic medication among patients with risky drug use.”

Some patients were willing to pay modest amounts out-of-pocket for access to their PCP over the Internet or telephone.

“Some were willing to pay modest amounts out-of-pocket for such service.”

In that 2010 U.S. record review, median standard costs were $161 for online visits and $219 for same-day acute visits.

“Median standard costs were $161 for online visits and $219 for same-day acute visits.”

• cites [132] 132. Rohrer JE, Angstman KB, Adamson SC, et al. Impact of online primary care visits on standard costs: A pilot study. Popul Health Manag 2010;13: 59-63. sourceNot checked — no full text of the source

Electronic scheduling with tracking improved access to referred specialty care.

“Electronic scheduling with tracking improved access to referred specialty care.”

A mobile phone messaging system among pregnant women in a developing country resulted in a 50% reduction in perinatal mortality.

“A mobile phone messaging systems among pregnant women in a developing country resulted in 50% reduction in perinatal mortality.”

Reliance on the electronic health record resulted in modest improvement in quality.

“Reliance on the electronic health record resulted in 9% decrease of office visits in a large health system over a 2year period, as well as modest improvement in quality.”

The cost of texting is lower than telephone reminders.

“Appointment reminders by telephone and SMS texting resulted in improved clinic attendance (converse of noshow) by about 10 percentage points, but cost of texting is lower.”

In that 2010 U.S. record review, the percentages of cost outliers in the two groups were 21.2% and 28.5%, respectively.

“The percentages of cost outliers in the two groups were 21.2% and 28.5%, respectively.”

• cites [132] 132. Rohrer JE, Angstman KB, Adamson SC, et al. Impact of online primary care visits on standard costs: A pilot study. Popul Health Manag 2010;13: 59-63. sourceNot checked — no full text of the source

E-consults indicated a moderate improvement in quality in some studies.

“Findings pertaining to the effects of e-consults (typically by telephone) indicated a moderate improvement in quality in some studies and equivocal findings in one study, which reported similar quality in the treatment of back pain but lesser quality in bronchitis.”

Sample size in intermediate outcome studies ranged from 153 to 376,795.

“Sample size ranged from 153 to 376,795.”

The technology used in most intermediate outcome studies consisted of telephones (including mobile phones, SMS messaging, and interactive voice response) and the Internet (including Web sites, electronic health records, and patient portals).

“The technology used in most of these studies consisted of telephones (including mobile phones, SMS messaging, and interactive voice response) and the Internet (including Web sites, electronic health records, and patient portals).”

Patients were generally in favor of sharing their visit notes with concerned family members and caregivers.

“Patients were generally in favor of sharing their visit notes with concerned family members and caregivers.”

Portal messaging was not associated with primary care visit frequency.

“Portal messaging was not associated with primary care visit frequency.”

Use of the Internet improved referral and booking.

“Use of the Internet had generally positive effects in several areas, including electronic scheduling appointments (29% improvement in specialty care), improved referral and booking, and identifying medication adverse events and addressing them.”

Interactive online access did not increase daily step count among patients who were overweight or had type 2 diabetes or coronary artery disease compared with controls.

“Interactive online access did not increase daily step count among patients who were overweight or had type 2 diabetes or coronary artery disease compared with controls.”

Use of the Internet produced similar results to that of the telephone in nurse-led telephone triage improving prompt follow-up for patients with appendicitis.

“Use of the Internet produced similar results to that of the telephone in the following areas: B Nurse-led telephone triage improved prompt follow-up for patients with appendicitis; also, nurse guidance over the telephone improved appropriate use of antibiotics for URIs.”

In a 2010 U.S. RCT of hypertensive veterans, during 2 years of follow-up, the cost-effectiveness of the intervention ranged from $42,457 per life-year saved for normal-weight women to $87,300 per life-year for normal-weight men.

“During 2 years of follow-up, the cost-effectiveness of the intervention ''ranged from $42,457 per life-year saved for normal-weight women to $87,300 per life-year for normal-weight men.''”

• cites [131] 131. Datta S, Oddone E, Olsen M, et al. Economic analysis of a tailored behavioral intervention to improve blood pressure control for primary care patients. Am Heart J 2010;160:257-263. sourceNot checked — no full text of the source

An algorithm-guided monitoring and analgesic management telephone intervention reduced pain.

“Similarly, an algorithm-guided monitoring and analgesic management telephone intervention reduced pain.”

Thirty-five studies met the feasibility/acceptance inclusion criteria during 2005-2015.

“Thirty-five studies met the feasibility/acceptance inclusion criteria during 2005-2015: 15 were conducted in the United States, and 23 were based on sample survey designs.”

Nurse guidance over the telephone improved appropriate use of antibiotics for URIs.

“Use of the Internet produced similar results to that of the telephone in the following areas: B Nurse-led telephone triage improved prompt follow-up for patients with appendicitis; also, nurse guidance over the telephone improved appropriate use of antibiotics for URIs.”

Telemedicine has significant potential to address many of the challenges facing primary care in today's healthcare environment.

“Telemedicine has significant potential to address many of the challenges facing primary care in today's healthcare environment.”

The Netherlands study demonstrated the importance of a 24-h teleconsultation service for GPs in dealing with daily dilemmas in palliative treatment of cancer patients during the last phase of their lives.

“We include this study here because it demonstrated the importance of a 24-h teleconsultation service for GPs in dealing with daily dilemmas in palliative treatment of cancer patients during the last phase of their lives.”

• cites [48] 48. Teunissen S, Verhagen E, Brink M, et al. Telephone consultation in palliative care for cancer patients: 5 years of experience in The Netherlands. Support Care Cancer 2007;15:577-582. sourceNot checked — no full text of the source

Primary care physicians are at increasing risk for decreased professional satisfaction and burnout.

“As a result, primary care physicians are at increasing risk for decreased professional satisfaction and burnout.32”

• cites [32] 32. Shanafelt T, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012;172:1377-1383. sourceNot checked — no full text of the source

Patient and provider acceptance is increasingly making telemedicine a viable and integral component of primary care around the world.

“patient and provider acceptance is increasingly making telemedicine a viable and integral component of primary care around the world.”

Challenges remain in standardizing methods to assess the cost of telemedicine.

“Challenges still remain in validating its impact on clinical outcomes with scientific rigor, as well as in standardizing methods to assess cost”

The projected shortfall of U.S. primary care physicians will be between 12,500 and 31,100 by 2025.

“According to the American Association of Medical Colleges, the projected shortfall of U.S. primary care physicians will be between 12,500 and 31,100 by 2025.”

• cites American Association of Medical CollegesNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Challenges remain in validating telemedicine's impact on clinical outcomes with scientific rigor.

“Challenges still remain in validating its impact on clinical outcomes with scientific rigor, as well as in standardizing methods to assess cost”

The small sample size of the intervention group in that 2007 study precludes any definitive conclusions.

“However, the small sample size of the intervention group precludes any definitive conclusions from this study.”

• cites [86] 86. Stroebel R, McLeod T, Kitsteiner J, et al. Clinical outcomes of patients with upper respiratory tract infections and acute sinusitis managed with a Web- based protocol in primary care practice. Manag Care Interface 2007;20: 17-22.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Physicians' concern over potential loss of patients' confidence when they look up information during clinical encounters may be exaggerated.

“Overall, these findings suggested that physicians' concern over the potential loss of their patients' confidence in them when they look up information during clinical encounters may be exaggerated.”

• cites [99] 99. Kahane S, Stutz E, Aliarzadeh B. Must we appear to be all-knowing? Patients' and family physicians' perspectives on information seeking during consultations. Can Fam Physician 2011;57:e228-e236.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The Teledoc study authors concluded that Teledoc users were not preferentially located in underserved communities.

“Teledoc users were not preferentially located in underserved communities.”

• cites [113] 113. Uscher-Pines L, Mulcahy A, Cowling D, et al. Access and quality of care in direct-to-consumer telemedicine. Telemed J E Health 2016;22:282-287. sourceNot checked — no full text of the source

In that Norway study, generalizing the findings beyond Norway may not be appropriate.

“Hence, generalizing these findings beyond Norway may not be appropriate.”

• cites [128] 128. Bergmo T, Wangberg S. Patients' willingness to pay for electronic communication with their general practitioner. Eur J Health Econ 2007;8:105-110. sourceNot checked — no full text of the source

• AssumptionRests on an assumption: In Norway, the copayment fee for an office visit is small, and patients' valuing of online access may be influenced by the small size of this fee in relation to the substitute.

The Brazil survey demonstrates the potential of telehealth to provide support to primary care practitioners in remote cities.

“thereby demonstrating ''the potential of telehealth to provide support to primary care practitioners in remote cities.''”

• cites [118] 118. Marcolino MS, Pereira Afonso dos Santos J, Santos Neves D, Alkmim MB. Teleconsultations to provide support for primary care practitioners and improve quality of care-the experience of a large scale telehealth service in Brazil. Stud Health Technol Inform 2015;216:987. sourceNot checked — no full text of the source

The VHA RCT concluded that telemedicine collaborative management increased the proportion of primary care patients with improved musculoskeletal pain by optimizing nonopioid analgesic medications using a stepped care algorithm and monitoring.

“Hence, the telemedicine collaborative management ''increased the proportion of primary care patients with improved musculoskeletal pain.byoptimizing nonopioid analgesic medications using a stepped care algorithm and monitoring.''”

• cites [122] 122. Kroenke K, Krebs E, Wu J, et al. Telecare collaborative management of chronic pain in primary care. A randomized clinical trial. JAMA 2014;312:240-248. sourceNot checked — no full text of the source

Many more studies were focused on intermediate outcomes because the connection between telemedicine intervention and clinical outcomes is not direct or clear.

“This also explains why many more studies were focused on intermediate outcomes.”

In the 2012 VHA randomized controlled trial, after 18 months there were no statistically significant differences in total VA medical care costs between treatment arms and usual care.

“After 18 months, ''.there were no statistically significant differences in total VA medical care costs between treatment arms and usual care.''”

• cites [133] 133. Wang V, Smith V, Bosworth H, et al. Economic evaluation of telephone self- management interventions for blood pressure control. Am Heart J 2012;163:981-986. sourceNot checked — no full text of the source

52% of patients were willing to pay for electronic communication with their general practitioner.

“52% willing to pay”

• cites Bergmo and Wangberg 128Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The median cost for e-visits was $161.

“median cost, $161”

• cites Rohrer et al. 132Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

40% of the control group dropped out.

“40% for control”

• cites Henderson et al. 135Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The average cost of secondary spells was $1,305 in the intervention group.

“intervention = $1,305”

• cites Nymark et al. 134Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The average cost of secondary spells was $1,678 in the control group.

“control = $1,678”

• cites Nymark et al. 134Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

32% of the telecare group dropped out.

“32% for telecare”

• cites Henderson et al. 135Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The proportion of cost outliers in e-visits was 21.2%.

“Outliers in e-visits, 21.2%”

• cites Rohrer et al. 132Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Online e-visits were associated with reduced cost outliers compared to in-person visits.

“Reduced cost outliers”

• cites Rohrer et al. 132Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Store-and-forward pediatric consultation resulted in significant cost avoidance from obviated evacuation.

“Significant cost avoidance”

• cites Callahan et al. 126Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.